APPLICATION FORM (Online request for membership in FM GROUP Club)

Sponsor’s Number First and Last name or name of the company if the Sponsor runs a business activity

Please enter the Sponsor’s number. In case you do not have a Sponsor, please leave the field empty – you will be automatically assigned a Sponsor who will be chosen randomly from the Leaders’ list.

Candidate's Contact Information

Date of the online registration*2012-02-08

Last name*

First name*

Please enter the Starter Kit code. In case you do not have a Starter Kit yet, please leave the field empty. After filling in the form you will need to order your Starter Kit.

Starter Kit code

Current address

Number, street, apartment number*

Postal code*

City*

Province*

Forwarding address (if different than the current address)

Number, street, apartment number Postal code City Province

Home phone number

Extension:

Mobile phone number

Fax number

E-mail address*

Please fill in the fields carefully and enter your valid e-mail address. After completing the registration you will receive an e-mail to the given address.

Company’s name if the Distributor runs business activity

Candidate states that:

(s)he has read the Regulations of FM GROUP Club Member and the Marketing Plan and fully accepts their provisions and is willing to participate in the FM GROUP Sales Network within the terms specified in the Regulations of FM GROUP Club Member and in the Marketing Plan.* yes
(s)he agrees to the processing and releasing of their personal data from the FM GROUP Canada and FM GROUP World database accordingly to the provisions of the Regulations of FM GROUP Member. yes
(s)he agrees to displaying by FM GROUP Canada their personal data on the Sales Network webpage accessible for other Sales Network participants (Distributors). yes no
If the Candidate does not agree to point 3 (s)he will be displayed on the Sales Network webpage under the appropriate Distributor’s Number.
(s)he commits to provide FM GROUP Canada (located at 1085 Bellamy Road North, Suite 14, Toronto ON) with an Application Form personally signed by her/himself and Sponsor including 2 signed copies within 30 days after the registration
will only use the Recipient Status and will purchase FM GROUP Products exclusively for her/his own needs and will not run business activity based on the direct sale of FM GROUP Products and performing advertising services for the network and FM GROUP trademark, nor will (s)he perform advertising services for the network and the FM GROUP trademark based on a mandatory contract. yes no
is an adult person. yes